High Prevalence of ESBL-Producing Escherichia coli and Predominance of blaCTX-M genes among faecal carriage isolates from children in Kassala State, Sudan

The emergence of ESBL-producing Escherichia coli (E. coli) has raised concerns over paediatric health, especially in developing countries. The present study was conducted to determine the prevalence and molecular characteristics of ESBL producing E. coli isolated from stool samples of children under five years old in Kassala State, Sudan. A descriptive cross-sectional hospital-based study of 404 Diarrheal children 2021-2024 E. coli isolates from stool samples were identified and cultured on MacConkey agar by standard microbiological techniques. Antimicrobial susceptibility was assessed by MicroScan. We used multiplex PCR for detection of ESBL genes (blaCTX, blaTEM and blaSHV). E. coli was found in 123 (30.4%) of 404 stool samples. The majority of the participants were males (60.2%) and were less than 1 year of age (51.2%). The resistance rates were alarmingly high for cephalosporins cefepime (84.6%), cefixime (87.8%), cefotaxime (85.4%) and ceftazidime (84.6%) but cefoxitin was less resistant (56.9%) Molecular investigation showed blaCTX (72.4%), blaTEM (69.1%) and blaSHV (30.1%) as the most prevalent ESBL genes. Carriage of ESBL genes did not explain phenotypic cephalosporin resistance (p > 0.05). We found troubling rates of blaCTX-M-positive ESBL-producing E. coli among Kassala State youth. Our findings underscore the importance of improved antibiotic stewardship, surveillance and infection prevention in this region.